MORE FOR MUSCLES PROGRAM

Transcription

1 MORE FOR MUSCLES PROGRAM User guide for physiotherapists and physiotherapy code list (ICD-10-AM codes) MAY 2018

2 WELCOME TO THE MORE FOR MUSCLES PROGRAM The program reimburses 100% of the agreed charge for an initial physiotherapy consultation, once per year, when your HCF patient presents with a new health condition or flare up of an existing condition that is represented by a More for Muscles physiotherapy code (ICD-10-AM) listed in this user guide. In the appendix you ll find a More for Muscles physiotherapy code list that was developed using ICD-10-AM codes. The use of these codes is the foundation of this program and reflect health conditions that are treated by physiotherapists. When you submit a claim for an initial consultation please select a code that most closely describes the provisional diagnosis made at the initial assessment and submit it to HCF as part of that claim. They have been grouped by condition (not ordered as they appear in the ICD-10-AM version 2010). Some codes may be repeated under different headings for easy reference. In this guide you ll also find instructions on how to successfully provide a quotation and claim a no-gap consultation on behalf of your patient. If you are making a More for Muscles HICAPS quotation request before you have assessed the patient - please use the ICD-10-AM code R69 to indicate this is an as yet unspecified condition. ICD-10-AM Tenth Edition: Copyright Commonwealth of Australia 2017 and based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) 2017 Edition Copyright World Health Organisation. All rights reserved 2

3 SOME THINGS TO REMEMBER The no-gap benefit applies to a member s initial consultation (item number 500) for a new episode of care. We define a new episode of care as a new health condition or an acute flare up of an existing condition where there s been a gap in treatment, with any physiotherapist, of at least 90 days. A member may claim this benefit once in a calendar year. A More for Muscles physiotherapy code (ICD-10-AM) must be submitted for every initial consultation (item number 500) that you provide to a member. You have agreed to charge no more than the program rate or your customary fee, whichever is lower. If the no-gap benefit has already been claimed by that patient in the current calendar year, the non-program benefit will apply. Services that are payable by a third party (e.g. workers compensation, personal injury, public liability or motor vehicle accident insurance) can t be claimed through HCF.

4 HOW TO SUBMIT A MORE FOR MUSCLES QUOTATION * / CLAIM THROUGH YOUR ELECTRONIC CLAIMS TERMINAL STEP 1 Select Function option and 6. Balance Enquiry/Quote (for quotations). Select the provider, patient ID, item number 500, date of service, and item cost as you would normally. STEP 3 (If you use a Healthpoint terminal then please skip to step 4). Enter the patient ID again. STEP 5 Enter the relevant More for Muscles chiropractic code ICD-10-AM from the appendix in this guide, OR if you are submitting a quotation request before assessing the patient, enter the ICD- 10-AM code R69. STEP 2 Select ADD to add another item. STEP 4 Enter or select the item code STEP 6 Transmit the claim or quotation summary to HCF or start back at step 1 for additional patients. *Quotations are only available on HICAPS terminals.

5 FREQUENTLY ASKED QUESTIONS What does ICD-10-AM mean? ICD-10-AM means the International Classification of Diseases and health related problems, 10th revision, Australian Modification. This is a nationally recognised standard. What does HCF do with the ICD-10-AM codes it receives? ICD-10-AM codes help us get a better understanding of the health of the population and the reasons why our members seek treatment from physiotherapists. Do I need to get my patient s permission before I transmit the diagnosis code through the claims terminal? No, the data is encrypted and we have our members permission to request and receive this information. What should I do if my terminal isn t working? If you can t collect payment through your claims terminal, please issue an unpaid account to your patient and print the More for Muscles physiotherapy code (ICD-10-AM) clearly on the invoice. Your patient will need to present the account as a claim and we provide a cheque to our member, made payable to you. What if I make a mistake when I enter the code? You can reverse the claim as you would normally. If you enter a code that isn t listed, you ll be prompted to start the claim again. What if I can t find the right code on this list? If you can t find the exact code you need, please use a code that most closely reflects your provisional diagnosis and send your feedback to provider_networks@hcf.com.au How do you define a flare up of an existing condition? When a chronic or long term condition flares up for which no physiotherapy treatment has been provided within 90 days. How will members know I participate in this program? We promote the More for Muscles program in our brochures and through our website. All participating physiotherapists are published on our website, so local members can find you. For any membership related enquiries, call our customer service team on

6 APPENDIX: MORE FOR MUSCLES PHYSIOTHERAPY CODES (ICD-10-AM) The codes are listed alphabetically (not in the order in which they appear in the ICD-10-AM version 2017). MUSCULOSKELETAL CONDITIONS/GROUPINGS HIP/KNEE/ANKLE/FOOT GROUPINGS Achilles tendinitis Anterior tibial syndrome, posterior tibial tendinitis (other enthesopathies of lower limb excluding foot) Arthrosis of hip (Coxarthrosis) Arthrosis of knee (Gonarthrosis) Calcaneal spur Derangement of meniscus due to old tear or injury Dislocation, sprain and strain of joint and ligaments at hip Dislocation, sprain and strain of joints and ligaments at ankle foot level Dislocation, sprain and strain of joints and ligaments of knee Disorders of patella Fasciitis - plantar Flat foot (pes planus) acquired Fracture of femur Fracture of foot except ankle Fracture of lower leg including ankle Hallux valgus (acquired) Iliotibial band syndrome Injury of muscle and tendon of hip Injury of quadriceps muscle and tendon Injury of adductor muscle and tendon of thigh Multiple injuries of hip and thigh Injury of Achilles tendon Injury of other muscle(s) and tendon(s) of posterior muscle group at lower leg level Injury of muscle(s) and tendon(s) of peroneal muscle group at lower leg level Injury of multiple muscles and tendons at lower leg level M766 M768 M16 M17 M773 M232 S73 S93 S83 M22 M722 M214 S72 S92 S82 M201 M763 S760 S761 S762 S797 S860 S861 S863 S867 6

7 Injury of other muscles and tendons at lower leg level Injury of muscle and tendon of the posterior muscle group at thigh level Injury of nerves at ankle foot level Injury of nerves at hip and thigh level Injury of nerves at lower leg level Internal derangement of knee Metatarsalgia Other bursitis of knee Patellar tendinitis Presence of hip implant Presence of knee implant Presence of ankle implant Traumatic ischaemia of muscle (including Shin Splints) Synovial cyst of popliteal space Bakers cyst Trochanteric bursitis Wrist or foot drop (acquired) LUMBAR SPINE/LOW BACK GROUPINGS Ankylosing spondylitis Fracture of coccyx Fracture of lumbar spine and pelvis Fracture of lumbar vertebra Fracture of sacrum Injury of nerve root of lumbar and sacral spine Low back pain Lumbar and other intervertebral disc disorders with myelopathy Lumbar and other intervertebral disc disorders with radiculopathy Sciatica Scoliosis Spinal stenosis Spondylolisthesis Spondylosis Sprain and strain of lumbar spine Sprain and strain of sacroiliac joint HEAD AND NECK GROUPINGS Ankylosing spondylitis Cervical disc disorders Cervical disc disorder with myelopathy Cervical disc disorder with radiculopathy Facial nerve disorders Fracture of neck Injury of nerves and spinal cord at neck level Migraine S868 S763 S94 S74 S84 M23 M774 M705 M765 Z9664 Z9665 Z9666 T796 M712 M706 M213 M45 S322 S32 S320 S321 S342 M545 M510 M511 M543 M41 M480 M431 M47 S335 S336 M45 M50 M500 M501 G51 S12 S14 G43 7

8 Other headache syndromes Polymyalgia rheumatica Spinal stenosis Spondylolisthesis Spondylosis Sprain and strain of cervical spine Temporomandibular joint disorders SHOULDER GROUPINGS Adhesive capsulitis of shoulder Bicipital tendinitis Brachial Plexus disorders including thoracic outlet syndrome Dislocation, sprain and strain of joints and ligaments of shoulder girdle Fracture of shoulder and upper arm Impingement syndrome of shoulder Injury of nerves at shoulder and upper arm level Presence of shoulder implant Polymyalgia rheumatica Rotator cuff syndrome THORACIC SPINE/MIDDLE BACK GROUPINGS Ankylosing spondylitis Fracture of rib Fracture of thoracic vertebra Injury of nerves and spinal cord at thoracic level Osteoporosis with pathological fracture Osteoporosis without pathological fracture Pain in thoracic spine Postural kyphosis Scheuermann s disease Spinal stenosis Spondylosis Sprain and strain of thoracic spine UPPER ARM /ELBOW/WRIST/HAND GROUPINGS Carpal tunnel syndrome Dislocation, sprain and strain of joints and ligaments at wrist hand level Dislocation, sprain and strain of joints and ligaments of elbow Fracture at wrist and hand level Fracture of forearm Injury of muscle and tendon at forearm level Injury of nerves at forearm level Injury of nerves at shoulder and upper arm level Injury of nerves at wrist and hand level G44 M353 M480 M431 M47 S134 K076 M750 M752 G540 S43 S42 M754 S44 Z9661 M353 M751 M45 S223 S220 S24 M80 M81 M546 M400 M420 M480 M47 S233 G560 S63 S53 S62 S52 S56 S54 S44 S64 8

9 Lateral epicondylitis Medial epicondylitis Myositis Palmar fascial fibromatosis ( Dupuytren) Periarthritis of wrist Presence of elbow implant Presence of wrist implant Radial styloid tenosynovitis (de Quervain) Rheumatoid arthritis unspecified Soft tissue disorders related to use, overuse and pressure Sprain and strain of wrist Synovitis and tenosynovitis Wrist or foot drop (acquired) WHOLE BODY GROUPINGS/GENERAL Arthritis unspecified Dislocation, sprain and strain of joints and ligaments involving multiple body regions Fibromyalgia Fractures involving multiple body regions Lymphoedema, not elsewhere classified Osteoporosis with pathological fracture Osteoporosis without pathological fracture Paget s disease of bone (osteitis deformans) Polymyalgia rheumatica Rheumatoid arthritis unspecified Stress fracture not elsewhere classified NEUROLOGICAL CONDITIONS/GROUPINGS Cerebral infarction Cerebral palsy Disorders of vestibular function Dystonia Guillain-Barre syndrome Hemiplegia Motor neurone disease Multiple sclerosis Muscular dystrophy Other degenerative diseases of nervous system, not elsewhere classified Other demyelinating disease of central nervous system Other diseases of spinal cord Other myopathies Paraplegia and tetraplegia Parkinson s disease CMC M771 M770 M60 M720 M772 Z9662 Z9663 M654 M069 M70 S635 M65 M213 M139 T03 M797 T02 I890 M80 M81 M88 M353 M069 M843 I63 G80 H81 G24 G610 G81 G122 G35 G710 G32 G37 G95 G72 G82 G20

10 Spinal muscular atrophy and related syndromes Stroke, not specified as haemorrhage or infarction BURNS Burn of ankle and foot Burn of head and neck Burn of hip and lower limb except ankle and foot Burn of shoulder and upper limb except wrist and hand Burn of trunk Burn of wrist and hand Burns of multiple body regions HEART DISEASE/CARDIOVASCULAR DISEASE Cardiomyopathy Chronic ischaemic heart disease Other pulmonary heart diseases INCONTINENCE/CHILDBIRTH Bladder disorder unspecified Multiple delivery Other assisted single delivery Other specified urinary incontinence Single delivery by caesarean section Single spontaneous delivery Stress incontinence PAEDIATRIC Congenital torticollis Congenital deformity of hand, unspecified Congenital malform upp limb incl shoulder Congenital malform low limb incl pelv girdle Congenital malform muscoloskeletal sys Down s syndrome Other congenital deformities of hip Cerebral palsy Talipes equinovarus, unspecified Other specified cong deformity spine Other specified cong malform limb(s) Congenital kyphoscoliosis RESPIRATORY Cystic fibrosis Chronic obstructive pulmonary disease Chronic respiratory failure Diseases of the respiratory system Asthma, without mention of COPD Bronchiectasis without mention of CF G12 I64 T25 T20 T24 T22 T21 T23 T29 I42 I25 I27 N329 O84 O83 N394 O82 O80 N393 Q6801 Q6810 Q7400 Q7420 Q7990 U882 Q6589 U8041 Q6600 Q6759 Q7489 Q7634 U782 U832 U835 U83 U833 U834 10

11 Acute respiratory failure Chronic respiratory failure J960 J961 NOTES 11

12 CALL US GO TO hcf.com.au/therapist The Hospitals Contribution Fund of Australia Limited. ABN AFSL HCF House 403 George Street, Sydney NSW 2000 Postal Address: GPO Box 4242, Sydney NSW 2001